FOOT IMPAIRMENT OF

Summary

The Veteran, a veteran who served from January 1983 to January 1987, appeals the denial of service connection for right foot pain. The Veteran contends this foot pain is secondary to his service-connected right tibia/fibula fracture with right knee impairment. The Board found the April 2020 VA examination inadequate because it was internally inconsistent, failed to address the Veteran's reported functional limitations, and omitted a discussion of aggravation. Specifically, the VA examiner stated the Veteran's pain did not impact his ability to perform occupational tasks despite the Veteran's reports of difficulty with standing and walking, and the examiner also failed to address aggravation. In contrast, the Board found the June 2024 private medical opinion from a podiatrist to be adequate. This opinion detailed the Veteran's biomechanical alterations and increased risk of foot pathology due to his in-service leg injury, opining it was more likely than not that his chronic foot pain was exacerbated by his military service and that the injury contributed to his altered gait and foot pain. Based on the Veteran's credible reports of functional impairment and the adequate private medical opinion, the Board granted service connection for the right foot disability.

Rationale

Private medical opinion found adequate and probative; VA opinion found inadequate due to internal inconsistency and failure to address functional impairment and aggravation; Veteran's lay statements regarding functional impairment were found credible

Full Decision Text

Citation Nr: A26008110
Decision Date: 01/28/26	Archive Date: 01/28/26

DOCKET NO. 200422-83521
DATE: January 28, 2026

ORDER

Service connection for right foot pain (a right foot disability) is granted. 

FINDING OF FACT

The Veteran's right foot disability is due to his service-connected right tibia/fibula fracture with right knee impairment (right leg disability). 

CONCLUSION OF LAW

The criteria for service connection for a right foot disability as secondary to a service-connected right leg disability are met.  38 U.S.C. § 1131; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 1983 to January 1987. 

In the April 22, 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on June 3, 2024.

Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran (or his representative) at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal but prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

Service connection for a right foot disability is granted. 

The Veteran is seeking service connection for a right foot disability that he contends was caused by his service-connected right leg disability. 

Generally, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. Service connection may also be granted on a secondary basis for a disability if it is due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

Pain that reaches the level of a functional impairment of earning capacity can constitute a disability. See Saunders v. Wilkie, 886 F.3d 1356 (2018).

A specific inquiry directly addressing aggravation, separate from whether a service-connected disability causes the disability at issue, is necessary when an examiner opines on secondary service connection. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). An examination that does not include a rationale as to aggravation is inadequate. El-Amin at 140.

The Board will now address the relevant evidence of record. 

The Veteran attended an April 2020 VA examination at which he reported experiencing right foot pain for approximately 30 years. He stated that this pain began after he fractured his right ankle (tibia/fibula fracture). The Veteran noted that his ankle was casted for six months and had to be reset three times. Regarding symptomology, he reported daily locking and an inability to walk long distances. He also stated that he felt as if his feet and ankles were in "electric shock," and it took approximately 90 minutes to get to sleep due to RLS (restless leg syndrome). With respect to functional loss or impairment, the Veteran reported that he could not run, jog, or jump. He also reported difficulty with prolonged walking, standing, or climbing. Of note, the April 2020 Disability Benefits Questionnaire indicates, "The Veteran does not have a current diagnosis associated with any claimed condition..." The examiner further noted, "Veteran is claiming [Arthritis], Right Foot Degenerative Foot Pain. He does not have [radiological] evidence of arthritis in his right foot, and Foot Pain (Arthralgia) is not considered a diagnosis." Also, despite the Veteran's statements, the examiner opined that his symptomology did not impact his ability to perform occupational tasks (e.g., standing, walking, lifting, sitting, etc.).

The examiner opined that the Veteran's right foot arthralgia was less likely than not proximately due to or caused by his service connected right tibia fibula fracture. To support her opinion, the examiner noted the
The Veteran does not have a current diagnosis associated with any claimed condition..." The examiner further noted, "Veteran is claiming [Arthritis], Right Foot Degenerative Foot Pain. He does not have [radiological] evidence of arthritis in his right foot, and Foot Pain (Arthralgia) is not considered a diagnosis." Also, despite the Veteran's statements, the examiner opined that his symptomology did not impact his ability to perform occupational tasks (e.g., standing, walking, lifting, sitting, etc.).

The examiner opined that the Veteran's right foot arthralgia was less likely than not proximately due to or caused by his service connected right tibia fibula fracture. To support her opinion, the examiner noted the following: "Review [of] SMRs shows h/o Rt TibFib Fracture (ankle), however there is no report or c/o right foot pain. There is no interim data. VHA Medical records show C/O right foot pain again in 2015. There is nothing in the currently accepted, peer reviewed, credible, and authoritative orthopedic [literature] that demonstrates that remote conditions of the ankle e.g. Rt Tib/Fib Fracture, Healed will cause intrinsic conditions of the foot. Based upon a review of the relevant evidence of record, history provided by the Veteran, and sound medical principles, it is this examiners opinion that the current condition of arthralgia, right foot is less likely than not proximately due to or caused by SC right [tibia] fibula fracture." The examiner did not address the issue of aggravation.

Shortly following the Board hearing, the Veteran's attorney provided a June 2024 private medical opinion regarding the relationship between his service-connected right leg disability and his right foot pain. The physician, a podiatrist, examined the Veteran and noted a decrease in ankle dorsiflexion and plantarflexion. He also noted pain on palpation and with weight bearing to his right second and third intermetatarsal spaces as well as right forefoot edema. 

The physician explained that the Veteran suffered from painful neuromas to his right second and third interspaces along with bilateral gastro-soleal equinus. He noted that the Veteran sustained a severe injury to his right leg during active service that required a full-length cast to his lower right extremity for six months. He further noted that it is well-known in the foot and ankle specialist field that an injury to this degree would greatly alter a patient's biomechanics and gait while also affecting the patient's ankle joint mobility. This altered gait pattern and reduced ankle joint range of motion would increase the biomechanical forces applied to the patient's right plantar forefoot which would place the patient at risk for certain pathology to the lower extremities, including the development of neuromas.

The physician opined that it is more likely than not that the Veteran's chronic right second and third neuroma pain was exacerbated during his time in the military. Also, his in-service right leg injury more likely than not contributed to his altered gait and biomechanical changes to the lower extremities which contributed to chronic right foot pain. 

To begin, the Board will address the adequacy of the medical opinions of record. In short, the Board finds the April 2020 VA medical opinion inadequate to decide the claim as it is internally inconsistent and fails to consider the Veteran's lay statements. As noted above, pain that reaches the level of a functional impairment of earning capacity can constitute a disability. Here, the Veteran clearly articulated difficulty with standing and walking due to his right foot pain, yet the examiner indicated that his pain did not impact his ability to perform these very tasks in an occupational setting, thus negating the presence of a disability. Additionally, the examiner failed to address the issue of aggravation. 

Conversely, the Board finds the June 2024 private medical opinion adequate to decide the claim as it is reflective of a thorough review of the record, physical examination, and requisite knowledge in the field. Also, the physician described the Veteran's disability with sufficient detail so that the Board's evaluation of the disability is fully informed. Even more, the physician provided a reasoned medical explanation regarding the relationship between the Veteran's service-connected right leg disability and his right foot pain. Coupled with the Veteran's credible reports of functional impairment, the Board finds that service connection is warranted, and the claim is granted. 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Graison-McBride, Kimberly F.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303. 


 is fully informed. Even more, the physician provided a reasoned medical explanation regarding the relationship between the Veteran's service-connected right leg disability and his right foot pain. Coupled with the Veteran's credible reports of functional impairment, the Board finds that service connection is warranted, and the claim is granted. 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Graison-McBride, Kimberly F.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.